Organization
MYSTIC MEADOWS HOME CARE SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WAYNE ANDERSON ELLIOTT (GENERAL MANAGER)
(434) 845-0709
Entity
Organization
Contact information
Practice address
6142 PLEASANT VALLEY RD, LYNCHBURG, VA 24504-4538
(434) 845-3318
Mailing address
6142 PLEASANT VALLEY RD, LYNCHBURG, VA 24504-4538
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
HCO09548
VA
385H00000X
Respite Care
HCO09548
VA
Other
Enumeration date
12/31/2009
Last updated
12/31/2009
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